Provider Demographics
NPI:1770339624
Name:BELLOMY, DELORA
Entity type:Individual
Prefix:
First Name:DELORA
Middle Name:
Last Name:BELLOMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17005 SPRENGER AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3049
Mailing Address - Country:US
Mailing Address - Phone:313-218-7115
Mailing Address - Fax:313-469-7966
Practice Address - Street 1:17005 SPRENGER AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3049
Practice Address - Country:US
Practice Address - Phone:313-218-7115
Practice Address - Fax:313-469-7966
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider